Ovali Fahri
Istanbul Medeniyet University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Istanbul, Turkey.
Medeni Med J. 2020;35(3):242-252. doi: 10.5222/MMJ.2020.77675. Epub 2020 Sep 30.
COVID-19 disease affects all ages, but severe cases of the disease and mortality are very rarely seen among children. In most cases, they acquire the virus from their parents or from an another infected person. The exact reasons why the disease has a milder course in children is unknown but high numbers of Angiotensin Converting Enzyme-2 (ACE2) receptors, underdeveloped immune responses, cross-reaction with other viruses, protective effect of fetal hemoglobin and fewer outdoor activities as well as journeys, and nonexposure to air pollution, and smoking. Although many cases are asymptomatic, they can still shed the virus. Materno-fetal vertical transmission has not been shown so far. In symptomatic cases, clinical findings include fever and respiratory symptoms, followed by diarrhea and vomiting. There are signs indicating a possible association between Kawasaki disease and COVID-19. Clinical findings and diagnostic procedures in newborns, and older children are similar. Supportive therapy is essential and antiviral agents are not required in most cases. During cytokine storm, anti-inflammatory treatments may be tried. There is no evidence for transmission through breastmilk; therefore infected mothers should breastfeed their infants by taking all precautions. Routine immunizations of children should not be deferred during COVID-19 outbreak period. Psychological support for children who need to stay at home and for healthcare personnel should be provided.
新冠病毒疾病可影响所有年龄段,但儿童中很少出现该疾病的重症病例和死亡情况。在大多数情况下,他们是从父母或其他感染者那里感染病毒的。该疾病在儿童中病程较轻的确切原因尚不清楚,但可能是由于大量的血管紧张素转换酶2(ACE2)受体、免疫反应发育不全、与其他病毒的交叉反应、胎儿血红蛋白的保护作用、较少的户外活动和旅行、未接触空气污染和吸烟。虽然许多病例无症状,但仍可传播病毒。目前尚未发现母婴垂直传播。有症状的病例中,临床症状包括发热和呼吸道症状,随后出现腹泻和呕吐。有迹象表明川崎病与新冠病毒疾病之间可能存在关联。新生儿和大龄儿童的临床症状和诊断程序相似。支持性治疗至关重要,大多数情况下不需要使用抗病毒药物。在细胞因子风暴期间,可尝试进行抗炎治疗。没有证据表明病毒可通过母乳传播;因此,感染的母亲在采取所有预防措施的情况下应进行母乳喂养。在新冠病毒疾病爆发期间,不应推迟儿童的常规免疫接种。应为需要居家的儿童和医护人员提供心理支持。